From the Guidelines
The left atrial (LA) volume measurements of 26.5 ml in the apical four-chamber view (A4C) and 17.0 ml in the apical two-chamber view (A2C) are within normal limits, suggesting no significant left atrial enlargement, as supported by the 2016 guidelines for the evaluation of left ventricular diastolic function by echocardiography 1. The stroke volume (SV) of 39.4 ml indicates the amount of blood pumped by the heart in each beat. The ejection fraction (EF) of 65.3% is within normal range (normal being 55-70%), suggesting good systolic function of the left ventricle, as indicated by the European Association of Cardiovascular Imaging 1. The cardiac index (CI) of 25.6 ml/m² represents the cardiac output adjusted for body surface area. These values collectively help assess cardiac performance, with the normal EF indicating adequate heart contractility. The LA volumes appear relatively small, which could be normal depending on the patient's body size and other clinical factors, as discussed in the context of left atrial function and its association with atrial arrhythmias 1. Medical professionals use these parameters to evaluate heart function, diagnose cardiac conditions, and guide treatment decisions for conditions like heart failure, valvular disease, or cardiomyopathy, taking into consideration the correlation with invasive left ventricular filling pressures and prognostic relevance of the echocardiographic diastolic parameters 1. Key points to consider in the evaluation of left ventricular diastolic function include the assessment of annular e′ velocity, average E/e′ ratio, LA maximum volume index, and the presence of tricuspid regurgitation signal, as outlined in the recommendations for the evaluation of left ventricular diastolic function by echocardiography 1. In clinical practice, these guidelines and recommendations are essential for making informed decisions about patient care, prioritizing morbidity, mortality, and quality of life as outcomes.
From the Research
LA Volume and Calculations
- The provided LA volume values are:
- LA A4Cs: 26.5 ml
- LA A2Cs: 17.0 ml
- The calculated values are:
- SV (A4C): 39.4 ml (Stroke Volume)
- EF (A4C): 65.3% (Ejection Fraction)
- CI (A4C): 25.6 ml/m' (Cardiac Index)
Assessment of Cardiac Structure and Function
- According to 2, heart failure with preserved ejection fraction should be suspected in patients with typical symptoms and signs of chronic heart failure, and echocardiographic findings of normal ejection fraction with impaired diastolic function confirm the diagnosis.
- 3 suggests that a more complete evaluation and understanding of left ventricular function in patients with heart failure requires a comprehensive assessment, incorporating measures of left and right ventricular function, left ventricular geometry, left atrial size, and valvular function.
Diagnosis of Diastolic Heart Failure
- 4 found that objective measurement of LV diastolic function serves to confirm rather than establish the diagnosis of diastolic heart failure, and the diagnosis can be made without the measurement of parameters that reflect LV diastolic function.
Prognosis and Mortality
- 5 states that presence and extent of coronary artery disease are strongly associated with all-cause mortality in patients with heart failure and reduced ejection fraction, and presence of CAD doubles excess mortality compared to a matched general population.
Ejection Fraction as a Diagnostic Tool
- 6 discusses the pros and cons of using ejection fraction as a diagnostic and prognostic tool, and whether its ongoing use is justified in the context of newer markers of LV function and the sophisticated questions posed by modern cardiology.